Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2021; 12(11): 1942-1956
Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1942
Adherence to Mediterranean diet and advanced glycation endproducts in patients with diabetes
Marko Grahovac, Marko Kumric, Marino Vilovic, Dinko Martinovic, Ante Kreso, Tina Ticinovic Kurir, Josip Vrdoljak, Karlo Prizmic, Joško Božić
Marko Grahovac, Department of Pharmacology, University of Split School of Medicine, Split 21000, Croatia
Marko Kumric, Marino Vilovic, Dinko Martinovic, Ante Kreso, Tina Ticinovic Kurir, Josip Vrdoljak, Karlo Prizmic, Joško Božić, Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
Tina Ticinovic Kurir, Department of Endocrinology, University Hospital of Split, Split 21000, Croatia
Author contributions: Grahovac M, Kumric M, Vilovic M, Ticinovic Kurir T, Martinovic D and Božić J for conceptualization, original draft preparation, and supervision; Grahovac M, Kreso A, Prizmic K, Vrdoljak J and Vilovic M for review of literature and visualization; all authors contributed to the final draft of the manuscript, have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of University of Split School of Medicine on November 29th, 2018. (Class 003-08/18-03/0001, No. 2181-198-03-04-L8-0059).
Informed consent statement: All study participants provided informed written consent prior to the study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joško Božić, MD, PhD, Associate Professor, Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split 21000, Croatia. jbozic@mefst.hr
Received: May 6, 2021
Peer-review started: May 6, 2021
First decision: June 24, 2021
Revised: July 1, 2021
Accepted: October 11, 2021
Article in press: October 11, 2021
Published online: November 15, 2021
Processing time: 192 Days and 22.2 Hours
ARTICLE HIGHLIGHTS
Research background

In recent years, major diabetic organizations started to strongly advocate the use of the Mediterranean diet (MD) over other diets in patients with diabetes mellitus (DM) because of its beneficial effects on glycaemic control and cardiovascular (CV) risk factors. Evidence suggests that CV risk may be assessed using tissue levels of advanced glycation endproducts (AGEs) in patients with DM.

Research motivation

As DM prevalence is constantly rising in well-developed countries, there is an urgent need to mitigate the poor outcomes of this disease. Regarding the importance of diet in this setting, we endeavoured to bring further evidence with respect to the benefits of the use of the MD in patients with DM.

Research objectives

The main objective of this study was to examine the association between adherence to the MD, assessed by MD serving score (MDSS) and CV risk, assessed by AGEs skin levels, in patients with DM type II. Additionally, we examined the association between anthropometric characteristics, glycaemic control, and physical activity with AGEs levels among patients with DM type 2

Research methods

In this study, we employed the Croatian version of the 14-item MDSS questionnaire to assess adherence to the MD. On the other hand, in order to compare adherence to CV risk, we used skin autofluorescence-based AGE Reader that measures AGEs skin levels.

Research results

The present study demonstrated that patients with diabetes who have none or limited CV risk adhere more to the MD than patients who have either increased or definite CV risk. In addition, we showed that the subgroup of patients with diabetes with better glycaemic control adheres better to the MD than the subgroup of patients with worse glycaemic control. Altogether, these results are generally in line with the available data. It remains to be answered why adherence to MD is so low, despite being undoubtedly beneficial.

Research conclusions

By bringing additional data about the association of the MD with CV outcomes, this study addresses the need to implement novel strategies that will lead to better MD adherence in patients with diabetes.

Research perspectives

In future studies, the highlight should be placed further delineation off mechanisms by which MD exerts its favourable effects to establish the optimal dietary pattern. Furthermore, psychological studies could be important in this setting, as the main problem of MD is low adherence. Namely, psychological studies may give a deeper insight into non-adherence, thus facilitating the resolution of this issue.